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After the permit is issued, schedule a site inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a conspicuous place on the premises. 77 Date: '_ Assessor's Parcel Number. Z Z- O- Legal Description: M $ -7 _ ` = { Building Site Address: 227Z L ( 26(� ( lr• WG,. Method of sewage disposal: jR, Septic O Sewer- name of district: Water source: O Individual Well O Community Well KPublic System, name of system: ' �yyyy yy�`�, -4 ct Name of Applicant: 0 ti Mailing address: City: State: (,(,G Zip: `7 G E-Mail Address: c , cow Day phone 73/_-7l© FAX phone: 3'60 2 7 11;C 440 Contact Person: INI' Proposed business name: T"V ,^ Proposed use: OFFIF G _ Number of employees: Previous business name: f�� 6 _ �"Ac�, Describe previous use: A i Check one: Q( Detached single level/single tenant O Single level/ multi tenant O Multi level/single tenant O Multi level/multi tenant Age of structure: Is structure cu,Xrently If not occupied, how long has it been vacant? occupied? Yes) No Yrs mos. _ Square footage: &P4t s : 400 _ Is the stru eated? Heating type: Circle one: Circle on Yes No Electric Liquid Propane Natural Gas Oil Type of he ircle on Furnace Heat Pump Electric baseboard or wa moun adiant Will there be any changes to the following? Circle yes or no, if applicable: Floor lay-out: Ys Lighting: Heating: Yes o Exterior Finishes e Interior Finishes es Parkin : Yes Number of restrooms pro a Number of es n each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system?Q Yes No Monitoring Station Name 4 2(L Phone number s360 '7 tax V% 1. Floor Plan(5 sets): • Draw the floor plan to scale `-, ✓� Use of rooms / • Room Dimensions � -jMzoy l • Location of all exits and windows (include dimensions) • Location of plumbingand mechanical fixtures • Interior doors with swing radius 2. Site Plan (5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields, &reserve • Well location • Surface&storm water run-off routes • Parking areas(number&arrangement) • Location of fire hydrants&vehicle access roads 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued. Accepted by�(fJ Date5­0'0 1 Submittal Amount$ r Receipt number Department Review Initials Date Comments Building Environmental Health Fire Marshal Planning Public Works Pre Application required? (circle one) Yes No Building Permit required? (circle one) Yes No Engineering Required? (circle one) Yes No Type of construction Occupancy Change? (circle one) Yes No New Occupant load: persons Occupancy classification change from to Existing occupant load design persons. Valuation: $ i COM .._ i MASON COUNTY TENANT REVIEW APPLICATION Complete the Tenant Review Application and return with a floor plan, site plan, septic pumper's report, septic records and $141.00 fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. During the evaluation of your Tenant Review Application staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices will identify compliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed/required a separate building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule a site inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a cons icuous elace on the remises. �a " =;k q ... _ _ Date: '_ C' O Assessor's Parcel Number: Legal Description: S Building Site Address: 2272 L ( "t26 4 f lr Wti, Method of sewage disposal: ig, Septic O Sewer— name of district: Water source: O Individual Well O Community Well R('Public System, name of system: (v Lt4kr �. ' 'M, , Name of Applicant: C) Mailing address: City: V- State: Zip: G E-Mail Address: " ` 144 Day phone:7,31_7(©1 FAX phone: 36 D 27 5_ 44,DO Contact Person: vy y r : Proposed business name: TN T Fx ecit,v ►-. Proposed use: 0 _ -' Number of employees: Previous business name: —11 LAB 0(,yL"&iu DescIribe previous use: O GIE Check one: 0 Detached single level/single tenant O Single level/multi tenant O Multi level/single tenant O Multi level/multi tenant Age of structure: Is structure cu ntly not occupied, how long has it been vacant? occu ied? Yes No TIf Yrs mos. Square footage: fN p4t s : - — — Is the stru eated? Heating type: Circle one: Circle on - Yes No Electric Liquid Propane Natural Gas Oil Type of he �rcle on Furnace Heat Pump Electric baseboard or wa moun adiant Will there be any changes to the following? Circle yes or no,if applicable: Floor lay-out: Y Lighting: Heating: Yes o Exterior Finishes es Interior Finishes es Parkin : Yes Number of restrooms pro a Number of es n each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No Monitoring Station Name 4 2(L Phone number s3(,C> f �c 1. Floor Plan (5 sets): • Draw the floor plan to scale/c Use of rooms • Room Dimensions G �"`-r[ ii r • Location of all exits and windows (include dimensions) • Location of lumbin and mechanical fixtures ! • Interior doors with swing radius 2. Site Plan (5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields, &reserve • Well location • Surface&storm water run-off routes • Parking areas(number&arrangement) • Location of fire hydrants&vehicle access roads 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued. 7 , ff, j �►ccepted by i (;..� Date.�' (�'"_� 1 Submittal Amount$_!i.�f�Receipt number � Department Review In' Date Comments Building Environmental Health Fire Marshal Planning Public Works Pre Application required? (circle one) Yes No Building Permit required? (circle one) Yes No Engineering Required? (circle one) Yes No Type of construction Occupancy Change? (circle one) Yes No New Occupant load: persons Occupancy classification change from to Existing occupant load design persons. Valuation: $ i com MASON COUNTY < TENANT REVIEW APPLICATION Complete the Tenant Review Application and return with a floor plan, site plan,septic pumper's report, septic records and $141.00 fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. During the evaluation of your Tenant Review Application staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices will identify compliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed/required a separate building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule a site inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a cons icuous Rlace on the eremises. ..NM i , r: Date: '_ C C7 Assessor's Parcel Number: Z �^ O._ 6 Legal Description: —r _ -r S Building Site Address: 2 272 L / --26 ( Y W4 Method of sewage disposal: jR, Septic O Sewer— name of district: Water source: O Individual Well O Community Well R(Public System, name of system: Name of Applicant: � Mailing address: City: State: Zip: 7 C E-Mail Address: " ` Day phone:7'31_-7(O FAX phone: 3'g p 27 5_ &+Z)o Contact Person: vi Proposed business name: 7N Proposed use: pFFf G _ -' Number of employees: Previous business name: oe Describe previous use: . <<ti�. �- � .... ,, :. , . a .. � ,. " .... ",... ,a," -��.' . ,r,�.�. ..r•� ;'u" n:�` > � r. . Check one: Qf Detached single level/single tenantp O Single level/multi tenant O Multi level/single tenant O Multi level/multi tenant Age of structure: Is structure currpntly If not occupied, how long has it been vacant? occupied Yes No . Yrs mos. Square footage: .{Is the stru eated? Heating type: Circle one: Circle on • Yes No Electric Liquid Pro ane Natural Gas Oil Type of he ►rcle on Furnace Heat Pump Electric baseboard or wa moun adiant Will there be any changes to the following? Circle yes or no, if applicable: Floor lay-out: Y Lighting: Heating: Yes o Exterior Finishes es Interior Finishes es Parkin : Yes Number of restrooms pro a Number of es n each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No Monitoring Station Name: 7-4 L(L Phone number: sj(,p f, 1. Floor Plan(5 sets): • Draw the floor plan to scale//__ � Use of rooms • Room Dimensions C sJG�"-'�l "" 11 • Location of all exits and windows (include dimensions) • Location of lumbin and mechanical fixtures 1c . Interior doors with swing radius 2. Site Plan(5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields,&reserve • Well location • Surface&storm water run-off routes • Parking areas(number&arrangement) • Location of fire hydrants&vehicle access roads 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued. t Accepted by i TO Date- '"4b`�� Submittal Amount$ III Receipt number Department Review I n W,71s2 PatelComments Building Z p Environmental Health Fire Marshal Planning Public Works Pre Application required? (circle one) Yes No Building.Permit required? (circle one) Yes No Engineering Required? (circle one) Yes No Type of construction Occupancy Change? (circle one) Yes No New Occupant load: persons Occupancy classification change from to Existing occupant load design persons. Valuation: $ " COM C c: MASON COUNTY - TENANT REVIEW APPLICATION : Complete the Tenant Review Application and return with a floor plan,site plan, septic pumper's report, septic records and ,.00 fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. During the evaluation of your Tenant Review dication staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices will identify npliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed/required a :parate building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, hedule a site inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be ,osted in a cons icuous elace on the premises. 5 l u . a d LA ,y a`6,. Date: '_ c" tj Assessor's Parcel Number: 2 Z— O-- Legal Description:.5AM' $ : ` _ S' Building Site Address: 2Z-7.2 L ( —(4O ( r (��,, Method of sewage disposal: Septic O Sewer— name of district: Water source: O Individual Well O Community Well /8('Public System, name of system: �� Name of Applicant: Mailing address: City: State: Zip: `J G' E-Mail Address: " ` C Day phone: FAX phone: 360 271;° Contact Person: � vi Proposed business name: T N Proposed use: G _ -' Number of employees: Previous business name: 7L(OD 11�L4C P Y u Describe previous use: C e Gl u�l Sbh Check one: 9 Detached sin gle level/single tenant O Single level/multi tenant O Multi level/sin le tenant O Multi level/multi tenant Age of structure: Is structure cu ntly If not occupied, how long has it been vacant? occu led? rYes No Yrs mos. Square footage: . P ff s Is the stru eated? He type: Circle one: Circle on Yes No Electric Liquid Propane Natural Gas Oil Type of he �rcle on Furnace Heat Pump Electric baseboard or wa moun adiant Will there be any changes to the following? Circle yes or no, if applicable: Floor lay-out: Y Lighting: Heating: Yes o Exterior Finishes es Interior Finishes es Parkin : Yes Number of restrooms pro e : I Number of Wxtffes7n each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system?Q Yes No Monitoring Station Name: e(L Phone number: 5360 ar 1. Floor Plan (5 sets): • Draw the floor plan to scale/�', � j Use of rooms • Room Dimensions C�yriz00 • Location of all exits and windows (include dimensions) • Location of plumbing and mechanical fixtures • Interior doors with swing radius 2. Site Plan (5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields,&reserve • Well location • Surface&storm water run-off routes • Parking areas(number&arrangement) • Location of fire hydrants&vehicle access roads 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued. . r Accepted b [>J Dates �'` 1 Submittal Amount$ ►q I _Receipt number Department Review Initials Date Comments Building Environmental Health Fire Marshal Planning 5 g i e- IT Public Works Pre Application required? (circle one) Yes No Building Permit required? (circle one) Yes No Engineering Required? (circle one) Yes No Type of construction Occupancy Change? (circle one) Yes No New Occupant load: persons Occupancy classification change from to Existing occupant load design persons. Valuation: $ i COM < MASON COUNTY - TENANT REVIEW APPLICATION Complete the Tenant Review Application and return with a floor plan,site plan,septic pumper's report, septic records and $141.00 fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. During the evaluation of your Tenant Review Application staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices will identify compliance requirements. This application is intended for tenant change only. If construction or remodeling is proposed/required a separate building permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule a site inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a cons icuous Rlace on the Bremises. g,Ny Date: '_ Assessor's Parcel NumberajFS& Legal Description:'A A4 $ —T—di_L ED ` .r .S Building Site Address: 2 L ( "�i7o O ( W4, Method of sewage disposal: sik Septic O Sewer— name of district: Water source: O Individual Well O Community Well R('Public System, name of system: (t44qi te v u Name of Applicant: bt Mailing address: City: State: Zip: 2- C95E-Mail Address: Day phone:7'31_'(0l FAX phone: 3'6 d 27 5_ &+00 Contact Person: � Proposed business name: T eV Proposed use: p G _ -i Number of employees: Previous business name: p6VP 4')u Describe previous use: O G Gl u4'_-4 S i'ria p�'ii k '�' tti � `m"� .r, n.xt.s;.p.,.;�r:.. �.�,...:�,..m,.,.� .., ..��`.. --.. k �a �"�5�c•s.T . - �'.�& ��J" �"� ..�, Check one: 0 Detached single level/single tenant O Single level/multi tenant O Multi level/sin le tenant O Multi level/multi tenant Age of structure: Is structure cu ntly If not occupied, how long has it been vacant? occupied? Yes No Yrs mos. Square footage: p.{ s : Is the stru eated? Heating type: Circle one: Circle on • Yes No Electric Liquid Pro ane C=Naturl Oil Type of he ucle on Furnace Heat Pump Electric baseboard or wa moun adiant Will there be any changes to the following? Circle yes or no, if applicable: Floor lay-out: Y Lighting: Heating: Yes o Exterior Finishes es Interior Finishes es Parking: Yes Number of restro6msproMte-F Number of es n each Is structure handicap accessible? Circle one Yes No Is the structure equipped with a fire sprinkler system? Yes No Fire alarm system? Yes No Monitoring Station Name: 2(L Phone number: s36C> -7 dl 1. Floor Plan (5 sets): • Draw the floor plan to scale/�, z"" t�oyj • Use of rooms • Room Dimensions C <J � • Location of all exits and windows (include dimensions) • Location of plumbingand mechanical fixtures • Interior doors with swing radius 2. Site Plan (5 sets): Note scale used • Property lines, easements, &right of ways • Location of all existing structures&dimensions • Distance, in feet,from property line&structures • Landscape buffer yards • On-site sewage tanks and drain fields,&reserve • Well location • Surface&storm water run-off routes • Parking areas(number&arrangement) • Location of fire hydrants&vehicle access roads 3. Septic records,pumper's report or O&M report. 4. Fees will be collected at time of submittal. Balance due will be collected when the permit is approved and issued. v Accepted b I �J Date5­ 0'09 Submittal Amount$ 1{ Receipt number Department Review Initials Date Comments Building Environmental Health i Fire Marshal Planning Public Works Pre Application required? (circle one) Yes No Building Permit required? (circle one) Yes No Engineering Required? (circle one) Yes No Type of construction Occupancy Change? (circle one) Yes No New Occupant load: persons Occupancy classification change from to Existing occupant load design persons. Valuation: $ 103 MASON COUNTY DEPARTMENT OF HEALTH SERVICES May 18, 2009 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 JACK JOHNSON Elma (360)482-5269 PO BOX 1119 BELFAIR WA 98584 Belfair (360)275-4467 Case No.: COM2009-00047 Parcel No.:123325000063 Dear Applicant: Your building permit will not be approved by Mason County Public Health until the following items are completed and received in our office. UPlease see comments at the end of this letter. Please call me at (360)427-9670, ext. 279 if you have any questions. Sincerely, Amanda Reynolds Environmental Health Mason County Health Services Comments: Need satisfactory pumpers report 5/18/2009 1 of 1 COM2009-00047 its, CID 1 C eU�R I m - ;v I eo N mto m — —D 0 cA Ns�Co n rrr m Oo OD p N (/� �<<�► p D n fTl N p Na O� rn N (.n m A O O �O{Z / Z / 3ro" / C� .00O Q, O CA o� ,� Sir• / �, / V firms 1S ' 1S Z8�3d1d cn n, PD JG LA CD f p Gd O '11,p co is o0 o s bo a)co WN '90 ao 6 w w --T Ln N pp'b4'26" W 68.59 t 4 F '{F 1 (•�•• ,`p� 4 5. 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